Provider Demographics
NPI:1144594391
Name:KLEIN, BRECK E (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRECK
Middle Name:E
Last Name:KLEIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAURENS ST NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3916
Mailing Address - Country:US
Mailing Address - Phone:803-648-8330
Mailing Address - Fax:803-648-8343
Practice Address - Street 1:400 LAURENS ST NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3916
Practice Address - Country:US
Practice Address - Phone:803-648-8330
Practice Address - Fax:803-648-8343
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861442519OtherNPI
SC4222080OtherNABP
SC744827Medicaid
DE1349OtherMEDICAID DME